In Ernest Hemingway’s The Sun Also Rises, a character asks someone, “How did you go bankrupt?” The other replies, “Two ways: gradually, then suddenly.” The passage is famous for its terse articulation of how it feels to realize a behavior that had been slowly working its way through one’s life has become inescapably dominant, seemingly overnight.

A lot of 2020 has felt that way, in both good and bad ways. Leaving aside hot-button issues of cultural and political import, much of day-to-day life is getting a major overhaul. Working from home, once a rare indulgence, became a necessity for white-collar employees, and many companies will keep generous flex time policies even when there’s no longer a health-related imperative. Online education, previously not much more than a punchline, is shakily beginning to get its sea legs. Shopping online went from steady growth to behemoth, with enormous consequences for retailers—and ODs. Those who rely on product revenue are clearly feeling the pinch.

This month’s issue unpacks numerous trends in optometry that have a transformative element—things like myopia control, telemedicine, artificial intelligence (AI), online product sales, private equity, subspecialization within optometry, genetic markers of eye disease and a new concept in E/M coding. Some are farther along than others in their impact on the profession right now, but all pose significant questions for optometrists: “Will this change how I practice? Should it?”

It’s likely that at least a few of these trends will. Artificial intelligence, for instance, is clearly on a trajectory that will shake up the traditional model of eye care delivery. In our personal lives, we already rely on the predictive algorithms in our computing devices that anticipate our needs by tracking how we shop, read news, watch TV and find dating partners. Medical imaging and diagnostic assessment is ripe for the same. If anything is going to follow the “slowly, then all at once” timeline, it’s medical AI.

So-called clinical genetics, in which doctors make medical decisions based on genetic data, has a checkered history in eye care. The controversy over AMD screening and AREDS vitamin formulations from a few years ago left many with the impression that genetics isn’t ready for prime time—then, the approval of Luxturna for inherited retinal dystrophies suddenly validated the role of gene therapy.

Optometric subspecialization has been discussed for decades but always faced obstacles at the institutional level over credentialing requirements and implementation challenges. It may never be wholly embraced—ODs perform 85% of primary eye care services, so generalists will always be essential—but those doctors who want to carve out a niche will find a formal path available to them.

If it all seems a bit too much to take in, just pick and choose. You don’t need to be an expert in everything. Just make sure you don’t get blind-sided by anything.